Michigan Presbyterian Pilgrimage

Request for Reimbursement

Please fill out completely, enclose receipts and mail to:

Rich Yeckley, Treasurer

65232 Fair Road

Sturgis, MI 49091

269.651.1352

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Date: _________________________

Name:  ____________________________________________________________

Address:  _______________________________________________________________

City:  ___________________________  State:  __________  Zipcode:  ______________

Telephone Number:  (       ) _______________  Email:  ___________________________

Description of expenses (please be specific and indicate area expense for)

 

 

Total for reimbursement:  ___________________
         Please provide copy of receipts for purchases

Signature:  ______________________________________________________

Budgeted Item_____  Non Budgeted Item_____  Approval Moderator/Rector ______

                                                                                    Initials of Rector or Moderator